Experts troubled by Canada’s euthanasia laws | Hacker News Reader

Experts troubled by Canada’s euthanasia laws

apnews.com

102 pointsbarry-cotter228 comments

To me, the only thing more ‘disturbing’ than a system which routinely fails its most vulnerable people by failing to provide adequate care and support for a good quality-of-life is a system which fails its most vulnerable people in that way and then also forces them to continue to suffer indefinitely.

I agree that we should not accept a system that does not provide everyone a good chance at a decent quality of life. I also believe strongly we should do everything we can to develop better treatments and cures.

At the same time, it is cruel to allow hubris or sentiment to blind us to the reality that, today, even the most well-allocated resources are finite, and our medical knowledge isn’t advanced enough to effectively treat—let alone cure—a huge number of non-fatal quality-of-life diseases.

Maybe Canada’s system needs more safeguards, maybe it doesn’t. It’s impossible to tell by reading this article, which is heavy on innuendo and light on data.

Systems will always have suboptimal outcomes regardless of how they are structured, advances that are made, etc. Everything has a cost, regardless of if you acknowledge it, see it, etc.

Generally speaking, vast majority of current negative health impacts are self inflicted and require no major breakthroughs; for example, diet and exercise.

I would phrase this somewhat differently to express the same sentiment: I object to a system in which my dog is practically guaranteed a better end than I am.

Exactly this. When we do it for our beloved pets, it is compassionate. When we do it for someone who specifically asked for it, under entirely similar conditions? Where is the difference?

People are getting hung up on their own issues around mortality, death, and autonomy around euthanasia and projecting onto others.

Safeguards are mandatory but so is free will.

Your dog doesn’t have the capacity to enjoy life by simply reading a book or watching grandchildren play.

This is not something I would like. I want to be able to choose, for myself, when the enjoyment I get out of life is outweighed by the suffering of illness or other afflictions.

Me too but what we have here in Canada is the situation where healthcare is denied and delayed. 1500 died in Ontario while waiting for surgeries in 2021 for example. Keep this course until euthanasia becomes preferable option?

Euthanasia can be favorable from both the individual and from society's perspective. I see no problem with that. We keep expanding life expectancy without asking ourselves if it's a good or desirable thing. I certainly wasn't asked and would like the option to opt out.

I also don't want lack a ressources be put forward as a justification to limit desired euthanasia making forced living even more unbearable..

Yeah, this is the problem. Euthanasia should be an option when treatment has failed, but the treatment should be tried first. This isn't a problem with euthanasia, it's a problem with the medical system. UHC systems remain popular so long as most people are happy--but most people don't need the expensive, ongoing care and thus it can become pretty poor for the patients that actually need it.

It's your opinion that reading a book and watching grandchildren is enough to make your life enjoyable, which is fine. That doesn't mean it is enough to make my life enjoyable, especially considering whatever difficulties I may be wrestling with, whether medical, emotional, financial, etc.

And no, more government resources may not always be able to mitigate my suffering. IMO it is horrible that we require a person to take their own life by violence (which is always allowed and cannot be prevented) rather than helping them take it in an easier way.

A personal story: my mother was 74 and developed a respiratory infection overnight. I was with her Friday night watching TV, but Saturday morning she didn't answer the phone. We went to her house and she was too weak to get out of bed and couldn't go to the bathroom. She said she just wanted to stay in bed but my sister talked her into letting us call 911. When they came, they said her oxygen level was 55, and that it would not be unusual for a person to die with that level.

She was put on oxygen at the hospital and they took an X-ray to confirm pneumonia. They wanted to do a bunch of tests but she refused. They said without the tests, she would probably die. She was okay with that.

Why would a 74-y/o who watched TV with her son the night before want to die? I'll tell you why: she had been in the medical system for the last 40 years with rheumatoid arthritis. She was on a walker because her last hip surgery didn't go well: they told her she would be driving within 2 weeks after the surgery, but instead, she was on a walker the rest of her life because her bones were unable to heal. The hospital said she'd have to drag an oxygen tank around the rest of her life. She could barely get around on a walker, so dragging around a tank would have been impossible. This is just the tip of the iceberg of her daily challenges.

I'm sure someone has "solutions" to all of her problems. But just because that would be acceptable to you and make your life worth living doesn't mean it is acceptable to others. Whether a life is worth living is a personal decision: the state or a bunch of "do gooders" cannot make this decision for a person.

I'm a firm believer that people should have the right to outline the circumstances ahead of time where they would prefer to die so that in the event they become unable to make this decision, they can die a dignified death. And if they are not incapacitated, people should have the right to make this decision for any reason, just like they can take their life by violence for any reason. I am not opposed to requiring a few counseling sessions to make sure they have considered all their options, but the outcome of counseling should not be used to decide for that person whether they should be allowed to commit suicide in a humane way. A person should always have that right, whether others agree with their decision or not.

I have seen people clinging to their lives no matter how insufferable those lives seemed to me

This is going to sound like criticism but I'm legitimately interested in understanding how you think and how you arrived at your opinions.

> I have seen people clinging to their lives no matter how insufferable those lives seemed to me

Sure there is no end of stories about people who want to live despite major setbacks. But what does that have to do with a person who doesn't? Is the person who doesn't wrong? Do you think they just have a bad attitude?

If we had two people with identical maladies, it seems to me that you are arguing that we should force Person B (who doesn't want to live) to continue living and suffering, because Person A does want to live. Please correct me if that isn't your view.

If instead we forced Person A (who wants to live) to die because Person B doesn't want to live. Would you see that as wrong/immoral?

Why must we force at all? What would be so wrong about letting the individuals (who are the ones experiencing the suffering) to decide?

I've lost people I care deeply for to suicide, so I know the pain that it can leave people with. However, it seems remarkably selfish to force others to live in misery against their will, simply because I want them to continue to live.

I am not arguing for forcing anyone to keep going against their will. I am arguing against the system that fails to provide care and treatment that people deserve while simultaneously nagging them towards euthanasia. Let’s consider the case when delaying or refusing some sort of surgery results in patient developing chronic pain. A few years later the patient is addicted to painkillers and suicidal. Now we perform euthanasia and forget about the original issue of failing healthcare system?

This. It's quite possible for the quality of life to go away even though there's nothing on the horizon that will kill or even one catastrophic problem. It can be like your mother--a series of things that add up to being alive but not having any quality of life.

I knew someone that chose suicide by dehydration after a fall. They perfectly well knew they had broken their hip and that the healing time for a broken hip (if it even did heal) was longer than their other medical issues would likely give them. Thus they were sentenced to remain lying in bed for the rest of their life. It was only in hindsight that her caretaker realized what had happened--at the time he didn't notice that she was drinking no more than needed to take her pills.

Thank you for posting this, it can't have been easy to spell it out but the naysayers are going to have to come to terms with reality as it is experienced by those that actually have lived through this instead of just armchair theorizing about why it does not apply to them.

A dog has the capacity to absolutely enjoy life by laying down and napping in front of their favourite dirty tennis ball.

The difference is that your dog isn't a member of a vulnerable population that the government and society has a political, social and economic incentive to kill.

Living in the US I can easily imagine our lawmakers and business people reading about this and staring longingly out the window at the homeless camps, wondering how to implement this here. Particularly in Seattle and San Francisco (which are already low-key at "war" with the homeless).

> "I object to a system in which my dog is practically guaranteed a better end than I am."

I would upvote this statement a million times if I could.

Yes, this is a poor and politically charged article; we don't have to read far to get to a beautiful application of Godwin's law:

> Tim Stainton, director of the Canadian Institute for Inclusion and Citizenship at the University of British Columbia, described Canada’s law as “probably the biggest existential threat to disabled people since the Nazis’ program in Germany in the 1930s.”

Euthanasia and assisted suicide is not murder. It's helping people who feel they don't have any other option.

What do you call assisted suicide that is not assented to by the subject?

A contradictio in terminis.

An impossibility. If there is no consent there is no "suicide", assisted or otherwise.

The term for what is done to pets and research animals is "euthanasia" — is that consensual? Or even "assented" or "acquiesced" to, if you want to side-step the question of how informed one has to be for it to count as "consent".

Pets are not people and cannot consent. Euthanasia is not assisted dying. There is no 'assistance' when one party doesn't share the goal. Straw man.

The previous comments, the link text, the article on the other side of the link, and the Canadian members of parliament debating this law all used the term “euthanasia”, so no, it is not a straw man.

Any reference to Nazis is not in itself an example of Godwins law. This is a discussion about state-run eugenics programs, so the reference isn't fallacious. Even Reductio ad Hitlerum acknowledges this[1]

[1]https://en.wikipedia.org/wiki/Reductio_ad_Hitlerum

A nitpick:

The Nazi “mandatory euthanasia” program began in December 1939, and continued until 1945. The first facility dedicated to killing the disabled opened in February 1940.

So it was the 1940s, not 1930s.

Absolutely everyone dies. I would argue that part of a respectable quality of life should include a respectable quality of death. There is so little dignity in death as it is.

But when death is immediately inevitable, and hastening it is comforting to the one experiencing it's immediate inevitability, it is not "selfishness" as one comment maintained, but perhaps "fright" over that level of compassion. It might feel like you're begrudging someone of a life, but you just might be begrudging them a death that they've already come to terms with.

That thought process makes it acceptable to keep a brain dead patient "alive" for decades. Is it common for them to come back after all that time of being clinically dead, and then enjoy life until the next time they die?

The argument I'm seeing in the threads about minor ailments such as hearing impairment are just silly because nobody is proposing such a thing. The article talks about his long term state of mind. There's a weird kind of alarmism that always jumps to really specific details, at the expense of the whole, that supposedly show a gap in the logic, but actually are the gap in that logic.

That seems to be the position of the Supreme Court of Canada, who ruled in 2015 that it would be cruel for the government to prevent Gloria Taylor (and others like her) to seek assistance ending her suffering (Carter v Canada). As part of their unanimous decision, they stated:

> It is a crime in Canada to assist another person in ending her own life. As a result, people who are grievously and irremediably ill cannot seek a physician's assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

Wikipedia summarizes:

> the Supreme Court held that the current legislation was overbroad in that it prohibits "physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

> After a lengthy delay, the House of Commons passed a Bill (C-14) in mid-June 2016 that would allow for doctor-assisted suicide in the case of a terminal illness.

https://en.wikipedia.org/wiki/Carter_v_Canada_(AG)

The law was further amended by Bill C-7 (43) after another court case in 2019 (Truchon v Canada). The Superior Court of Quebec struck down the clause that restricted MAID to patients whose death was reasonably forseeable. From an unofficial translation of the decision:

> [The plaintiffs] claim that the reasonably foreseeable natural death requirement is tantamount to a prohibition of medical assistance in dying for any person who, like them, is not at the end of life. In this sense, it forces some of these individuals to take charge of their own destiny and take hasty steps to end their lives prematurely out of fear that they will no longer be physically able to do so once their suffering becomes intolerable. Consequently, they claim that the reasonably foreseeable natural death requirement exposes them to a heightened risk of death and, therefore, infringes on their Charter right to life.

The legislative background for C-14 (42): https://www.justice.gc.ca/eng/rp-pr/other-autre/ad-am/p2.htm...

The legislative background for C-7 (43) https://www.justice.gc.ca/eng/csj-sjc/pl/ad-am/c7/p1.html

The current text of the law: https://laws-lois.justice.gc.ca/eng/acts/C-46/section-241.2....

What you need is a government equation to help. There should be a well thought out form, with simple answers that can allow someone who has undertaken the prerequisite amount of training to complete the form. With the right information, it would really be very simple, programmable even, to work out what one should do with the person.

The whole point of the article is that Canada's system needs safeguards. Other countries have them. This is not a black and white pro- or anti- assisted suicide article. Killing someone for having depression and deafness is not the same as for having terminal cancer and constant pain and being bedridden.

This is really not a decision for the individual patients to have freedom in. I know multiple young people who have been suicidal and attempted it. Most survived but more could be dead if they were able to simply ask the doctor for it and it was all easy and painless.

> The whole point of the article is that Canada's system needs safeguards.

If this were truly the point of the article, it would have spent less time trying to make emotional pleas and implying that assisted suicide for non-terminal patients is somehow immoral and/or a direct road to eugenics. Canada’s system does have safeguards, and whether or not they are good enough is not actually answered by a couple anecdotes and some comparisons to other countries.

> Killing someone for having depression and deafness is not the same as for having terminal cancer and constant pain and being bedridden. This is really not a decision for the individual patients to have freedom in.

There are conditions that don’t bother me at all that others would suffer with immensely, and there are many people living happy lives with conditions that I would absolutely want to kill myself over. It is incredibly paternalistic to believe that you (or I) can decide whether or not someone else’s suffering is ‘enough’.

> I know multiple young people who have been suicidal and attempted it. Most survived but more could be dead if they were able to simply ask the doctor for it and it was all easy and painless.

I am genuinely sorry to hear that you have had those experiences and I can tell that they have had an impact on you. However, it is not possible for someone to just walk into a doctor’s office in Canada and get wheeled into the morgue an hour later, and as far as I am aware no one is suggesting that it should be so.

I would encourage you to shift perspectives here and start thinking about how creating a safe, legal, and painless way to end one’s life could reduce the sorts of impulsive suicides it sounds like you’ve seen. For some, just knowing that the option is available makes hard times in life feel much more bearable. For others, the guarantee of an easy and painless assisted death makes the idea of trying to kill themselves on their own a risky and unpalatable alternative.

The more that suicidal people believe that going to see a professional is a better idea than taking things into their own hands, the more people will be able to have their quality of life improved by interventions other than death. And for those who are beyond improvement with today’s resources and technology, at least they too will be able to stop needlessly suffering.

I come from a country which just legalized euthanasia and part of the safeguards we have is to try to be very sure that nobody takes it because they're suicidal due to depression. That might not be truly fair since some people might really be suffering that badly from it, as you say. But I came into this discussion with the prejudice that depression was an important reason to deny suicide assistance and the article gives an example of somebody who apparently died because of it.

You seem to be more open minded and consider depression might be an acceptable reason for doctors to kill their patients on request, if the patient really really wants it?

In short; if we can't take care of them we ought to be able to at least off them?

In short; if they decide we can't take care of them and they wish to off themselves, we ought to honor that decision.

Yes and in response we should abandon more people so they voluntarily choose to off themselves. It is consent all the way down.

My uncle just 'chose to die'. And rightly so. He suffered from a very bad case of cancer that caused him incredible pain. Physically he could have probably lived on for another three to six months but it would have been three to six months in hell. He was quite literally screaming from the pain, even through the heaviest sedatives, the only thing that would have stopped that would have been an artificial coma.

Euthanasia is a godsend for situations like that and if you are against it for some reason understand that there is not such thing as an impulsive act to euthanize, that the medical profession is well capable of weighing whether you are just off your rocker for a day or two or if there is a legitimate cause. Way too many people argue about this stuff without having thought through the consequences and the possibility that one day they themselves may well be begging for that kind of relief.

Obviously, coercing people to choose the option to die and pressuring them with the cost of their treatment should be off the table entirely and should be - as far as I'm concerned - prosecutable.

Very sorry for your loss.

> Way too many people argue about this stuff without having thought through the consequences and the possibility that one day they themselves may well be begging for that kind of relief.

Yes, could not agree more. I see the same thing when arguing with people about accessibility to pain medications, where people who are generally healthy and not tormented by chronic pain want to throw roadblock after roadblock in people's way, and support policies that take away pain medication from people who need it which is literally torture. These people view addiction as

We like to think that we moderns are so much more enlightened than people of the past who engaged in extreme cruelty against others, but in reality we're still pretty horrible. We just do it now through a mix of apathy (out of sight, out of mind), hubris, and moralism, by building a system in which people aren't free to make their own medical decisions but instead are forced to concede to the dictates of another. It's no doubt progress given where we started, but we still have a long way to go. I am optimistic that at some point people will learn empathy and humility, and stop projecting their own thoughts/beliefs/opinions onto others by coercion.

I love this quote from CS Lewis:

> "Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.

> They may be more likely to go to Heaven yet at the same time likelier to make a Hell of earth. This very kindness stings with intolerable insult. To be "cured" against one's will and cured of states which we may not regard as disease is to be put on a level of those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals."

What strikes me as the common element in all those situations is that it is always people deciding how others should live or act. It's never about them, they are doing just fine. But others, those should abide by the fairly arbitrary restrictions thrown up. Either because of religion, or because of fear there is always some button that can be pressed to get people to tell other people how they should live their lives.

You can see this in almost every ethics debate, be it about gay marriage, euthanasia, treatment of prisoners, immigration, abortion etc. And as a rule it's the same 'busybodies' as you call them on the wrong side of the argument.

For some more context, in 2020 about 2.4% of all deaths (7,383 people) were euthanasia related. And the vast majority were over 60. Extracts:

“In 2017, 2,838 medically assisted deaths were reported by Health Canada, compared with 4,478 deaths in 2018. In 2019, there were 5,425 medically assisted deaths in Canada, accounting for 1.9% of all deaths. In 2020, this increased to 7,383 deaths (2.4% of all deaths in Canada)” [1]

And

“applicants were on average 74.8 years of age. People under 60 years of age make up 11.3% of all MAID applicants. ” [1]

So about 0.26% of all deaths in 2020 were under 60s euthanasia.

1. https://www150.statcan.gc.ca/n1/daily-quotidien/220110/dq220...

Sounds about like what I would expect. Old age with an incurable degenerative disease is living in hell, so it's no surprise people take the option if it's available.

But safeguards must be put in place to prevent people with a history of depression or mental diseases to be approved, it's simply an impossible decision for the state to make even if it would legitimately benefit some of them.

Do people with history of depression and mental diseases suffer? Do they have a right to end their suffering?

Yeah. Major depressive disorder is absolutely suffering. You should not force people to live with it, especially if they have sought professional help without success.

What if they've sought "professional help" and been turned away / denied due to lack of cash on hand? What if they also have physical medical issues that could get solved except for that whole pesky "cash on hand" thing? What if they've suffered for many years and now just want to give up and end the suffering?

I believe it should be their choice to make. The case in which I'd be skeptical is if someone were just beginning to experience mental illness. The onset of mental illness can be very difficult, confusing and disturbing. People often don't know what's happening to them and they don't know what treatment may be able to do for them. To allow them to choose suicide in an dark early moment of their disease which may stabilize seems callus to me.

I'm not sure how you structure this limitation but bottom line is anyone with significant experience of their own mental illness who doesn't want to live with it anymore shouldn't have to.

The whole point is that they are unable to make that choice. A substantial decision made in sound mind implies rationality, which mental disease, by definition, diminishes.

If you equate a person's rational choices with everything that comes out of their mouth, then you will euthanize a whole lot of mentally troubled or people.

Just because someone is experiencing mental illness doesn't mean they are irrational.

I'm not even sure it's possible to divide the world between "mentally ill" and "mentally well". And if you could, I'd be inclined to say almost anyone who has been in serious chronic pain for years cannot possibly be considered "mentally well". Pain takes its own toll.

Depression absolutely makes people irrational. It changes your risk calculus. Are we going to act like other disorders such as bipolar are rational and should be listened to whenever at face value?

It can make you irrational. It doesn't necessarily. You are acting as if all mental illness is experienced uniformly the same across all people. It is not. And as if the severity does not vary over time. It does.

And dependimg the disease condition of the bipolar suferrer yes. Depending upon their stability which varies heavily from case to case and individual to individual. Would you want to do so at the peak of mania or the trough of depression, probably not.

I don’t think it should be a decision for the state to make at all, and certainly not one where a history of depression or mental disease would be permanently barring.

"we don't want to let people end their life humanely because I think I know better than them about their life. Instead they can end their life inhumanely anyways." - I rewrote what you were saying to make its intent clearer.

> Instead they can end their life inhumanely anyways

That's an option that always exists. I simply have a (much) higher threshold than you in regards to a state killing its own citizens.

It's not the state that kills, it's the patients that request to have their life ended to avoid interminable suffering.

This sort of framing is not helping the discussion at all.

"I think 18 year olds should be able to end their lives because they got a bad grade in a class and who knows their life better than them" — I rewrote what you were saying. This strawmanning stuff sure is easy!

Patients aren't always rational actors. In the US at least, doctors have < 25 minutes per person. There are well documented biases in medicine (try getting your tubes tied as a single woman) and my concern is that it very easily veers into eugenics territory. If we can't treat something why not screen for it in utero and terminate pregnancies with appreciable odds of developing terminal or chronic diseases with no known cures?

If they're 18, and can fight to die in foreign sands over oil. They can choose to end their life too. At some point people have rights, and you will respect that.

It is easy to put people in situations that make them contemplate suicide, deprive them of enough sleep they will become depressed and eventually get in horrible mental states that they want to end and that is the problem, people don't want to die, they want to avoid bad mental states, they want to be healthy. By just euthanizing everyone willy nilly you are depriving them of their option to be healthy and eventually we will continue justifying toxic environments by saying that you can always "leave" if you don't like it.

As an old guy with an incurable disease, nothing is more frightening than people who want me to die before I'm ready to go.

Having gone through depression, I think there needs to be a higher bar for euthanasia. Yes there are terrible incurable sufferings that may need it, but making it available widely with no counter measure is a very dangerous proposition.

> making it available widely with no counter measure is a very dangerous proposition.

Why? And, dangerous to whom?

Dangerous to the people who would impulsively choose to be euthanized?

Canada has a 90-day assessment/waiting period for those whose deaths are not reasonably foreseeable. They won't euthanize you unless you seem capable of making the decision and have thought through it for an extended length of time. It's not an impulsive thing.

And yet, "Within a month, Nichols submitted a request to be euthanized and he was killed" which is pretty quick considering median waiting time of 25.6 weeks between referral from a general practitioner and receipt of treatment[1]

[1]https://www.fraserinstitute.org/studies/waiting-your-turn-wa...

But, isn’t it their choice? If they are adults, and have lived at least a few decades..

I’ve never figured out why we as a society want to impose our morality on others.

I find this statement a bit too generic. Should society allow everything happening between consenting adults?

Shouldn't it?

Between "consenting" adults that doesn't involve anyone else, absolutely..

Could you give an example when it shouldn't be allowed. It's certainly possible I'm not considering everything.

There was this case a while ago of a wannabe cannibal who found someone who wanted to be eaten. The cannibal was arrested. Are you saying he shouldn't have been and it was perfectly fine for him to eat a consenting adult?

And admittedly I'm reaching right away for the edgiest of edge cases.

Edit to add the link: https://en.m.wikipedia.org/wiki/Armin_Meiwes

To me the important issue is incurable.

If there is reasonable hope for the situation to get better then death is almost certainly the wrong answer. If the situation can't be fixed I see it as the patient's choice as to whether the situation makes life worse than death. I don't believe any outsider can make that decision for somebody. (However, I do think people who knew someone well might be able to know what somebody's wishes were. I knew how my mother felt--if the hospital can't fix her up enough to send her home then palliative care only. In a society that permitted euthanasia it would be that rather than palliative care only.)

It is entirely possible that there should be changes to the laws, but involving families is a terrible idea. You aren't going to get rational decision making if you ask someone about their mother wanting to die. You'd be lucky of you didn't get someone screaming profanity at the medical staff for an hour.

On the other hand you would be surprised how many families embrace it and come together and celebrate their passing with the individual. Of course they are sad as well but they are also happy with the decision to give the client peace. I am a health care worker and occasionally get sent to work at a hospice house and have been present when MAID was being done.

My mom died this year; liver and kidneys failed, lungs filled with fluid, suffocating, maximum oxygen support in the hospital. After several days, she was too tired to go on, went with "comfort care", supposedly minimizing suffering, but it's a euphemism for torture. I stayed with her for half an hour after they took off her oxygen mask before I couldn't take it any more -- my mother gasping for breath. After about an hour I was told she'd passed away so I should go back in -- to see her frozen with her jaw locked forward, desperately trying to get a breath. I hate anyone who claims euthanasia is wrong. Why couldn't they just replace the oxygen with nitrogen?

I am very torn by these developments. A dozen plus years ago someone close to me had ALS, a horribly vile disease that to this day is a death sentence upon diagnosis. Think of a judge saying to you "you will serve two years of daily punishment each day worse than the previous after which you will die". Medical care is capable of sustaining life well beyond the capabilities of the body by itself.

On the other hand, this should not be available to someone who has "hearing loss" and is possibly not in a position to make good decisions.

You might be surprised the suffering hearing loss can cause. I remember a story about a man who killed himself to make the ringing in his ears stop [1]. And if you decide their suffering doesn't make the cut and don't provide people with a way out, you might find they'll just take matters into their own hands.

1. https://www.dailymail.co.uk/news/article-1376787/Tinnitus-su...

> On the other hand, this should not be available to someone who has "hearing loss"

Why? Should they jump off a bridge instead?

> and is possibly not in a position to make good decisions.

Who are you to tell?

He had a documented history of depression. By definition, he was not in sound mind, there is ample precedent of people suffering from depression, trying and failing to commit suicide, and later recovering and thanking those around them for saving them.

This idea that "one's mind is sovereign over their destiny" is unsustainable in practice. There are many versions of it floating around, for example related to gun control issues. You just can't create policies that ignore the reality that a large portion of people are not rational a large fraction of time.

If we prevented all suicides there would be _well more than ample_ precedent of people trying to commit _and being stopped from_ committing suicide and later hating everyone for keeping them in hell.

You can't ignore downsides just 'cause you see upsides.

The question I have is, are they thanking people for saving their life, or simply thanking them for showing them some love. For enough cases, and especially this one, once that love-in wears off, it's back to figuring out how to die.

Wanting to die, and appreciating the expression of love in your direction, are not opposites.

> Why? Should they jump off a bridge instead?

At least then there will be less lingering suspicion that he was pressured into it for being a cost point. And unlike in the usual AS hypotheticals, (but like most actual assisted suicides), he was perfectly capable of it. He didn't need assistance.

If you say, "my life is not worth living", maybe that's your call to make. But I think it would be very, very, wrong of me to answer, "Yes, your life is not worth living". Especially if I was your doctor.

Involving other people in your suicide, trying to get them to validate your decision, is deeply wrong. It's far worse than things like "emotional burden on your family" like suicidees are often accused of inflicting. It's no wonder that after this has been law for a while, doctor's moral sentiments are sufficiently sabotaged that they start encouraging it for people they see as a burden.

> At least then there will be less lingering suspicion that he was pressured into it for being a cost point.

How? Sure, the doctor probably didn't actively recommend it. But medical costs could very well be a significant factor in such an action.

Except that for some of us, society has already decided for us that our life isn't worth living (often without even knowing the first thing about us other than that we currently this instant don't have a bunch of money to give away to others who might be able to save us from suffering or dying), by denying many of us basic medical care (in so-called "rich" nations, even), yet the general consensus seems to be that while we apparently don't deserve to live, we also don't deserve a dignified death, but rather ongoing and growing misery and pain until we either die of "natural" causes (societal neglect) or take our own lives in some messy and possibly dangerous way.

That's a separate issue as I see it. It isn't helped by doctors with expenses targets to meet "giving you information" on how they can help you end your life.

> If you say, "my life is not worth living", maybe that's your call to make. But I think it would be very, very, wrong of me to answer, "Yes, your life is not worth living". Especially if I was your doctor.

That's is _not_ what is being asked of the doctors. They are being asked to determine whether the patient truly believes their life isn't worth living. They are trying to determine if the patient is clear of mind in his or her decision-making. It would be unprofessional and _wrong_ of a doctor to somehow make this decision about them.

Frankly I think you have it entirely backwards. The patients are trying to remove the state's prerogative to block their suicide. They aren't asking you to validate their decision; they are trying to remove you from the equation entirely. They want to be allowed to make decisions about their bodies and their lives _themselves_.

I honestly find your position exceedingly selfish and callous. Your personal feelings of suicide simply do not matter when it comes to others' choices about how they'd like their lives you end.

You are calling me heartless for suggesting that suicidal people often crave approval for their decision. I can't see how that's heartless unless we ARE expected to support their decision, which you say we aren't.

My personal feelings about suicide become relevant when others start involving me in their suicide. I can't just "get out of the way" when I am put in that position. (The state has already gotten out of the way, as long as suicide is legal, which ofc. it should be)

The elephant in the room is that most assisted suicides, including the one in this article, happen with people who would be capable of doing it on their own.

> My personal feelings about suicide become relevant when others start involving me in their suicide.

I'm really confused. I mean I assume you must be a doctor right? If not, literally none of this makes any sense since you're not being included in anything.

Regardless, your job as a doctor would be to determine whether a terminal patient making a decision to end his or her life is clear of mind. That is it. You wouldn't be approving of their suicide.

Your position is basically the epitome of selfishness. You are taking something that is not about you and making it about you. Your emotions simply do not matter. Grow up and understand that the world doesn't revolve around you. People shouldn't have to go through unnecessary suffering because you for some reason take their own entirely personal decisions about their own lives and make it somehow about you.

Why should anyone else than the victim have the right to decide what suffering is "good enough" for them?

Without working earing you can get severely isolated which make you life miserable. My mother is loosing hearing, but she lack the mental abilities to learn sign language or even lip reading. She doesn't have the strength and memory to read book. Her existence will soon be reduced to looking at a white wall for most weaken hours.

Note that it was not only hearing loss but he was losing vision also--at that point you have no high bandwidth input channel, effectively little better than a life sentence of solitary confinement.

This is all very disturbing: price people out of care and convince them to consent to die.

I think if someone wants to end their life, they can just stop eating and drinking. If you just stop eating it will take longer, but will still work.

Someone with grave health problems will often have little appetite.

A friend who nearly died with a running car engine in a closed garage says it's an easy way to go.

The main consideration for the person choosing to end their life is that the measure they choose be reliably effective, as an incomplete death (oxymoron?) will likely entail further suffering.

The seminal reference on the topic in the US is Final Exit, by Derek Humphry.

https://www.amazon.com/Final-Exit-Practicalities-Self-Delive...

We made the difficult decision to euthanize our dog last summer. Sure, we could have just stopped feeding her or additionally stopped allowing her water to drink.

If we’d done that instead, how would we be judged? How much of that judgment would result directly from the idea that, despite there being a more humane and compassionate alternate, we chose to prolong her suffering needlessly?

The operative word you've used is "euthanize" which is definitively different than "suicide" or even "assisted suicide". You're conflating the method of ending life with the person doing the ending. OP is talking about suicide and methods in which an individual may do it, you're talking about euthanasia trying to draw comparisons between a person deciding and committing suicide and you deciding to euthanize your dog. They are not the same.

You can always pick an extreme example of drooling, pants-shitting, etc. etc. But the problem is that "option to die" usually morphs into "duty to die" and then into "involuntarily dying."

“Usually” is doing a metric shit-tonne of work there.

see above

Does it now? Can you cite any examples?

The article is the example.

There are massive systematic pressures on our healthcare system and the 'oldest' people who don't work or pay taxes are the big 'cost points'.

Eugenics was very popular among Progressives across western Europe as well as the US. Compulsive sterilization, certification of marriages to avoid unwanted breeding of undesirably character or deformity and worse were considered "the science" of the time, and a moral virtue among a fair few Christian sects as well. Fundamentalists and Catholics were among the few religious groups in the US who opposed it, and were ridiculed as ignorant.

The evils perpetrated in the death camps and elsewhere were nothing more than the logical end conclusion of eugenics in general.

There's evidence in the article this story is about:

"Roger Foley, who has a degenerative brain disorder and is hospitalized in London, Ontario, was so alarmed by staffers mentioning euthanasia that he began secretly recording some of their conversations.

In one recording obtained by the AP, the hospital’s director of ethics told Foley that for him to remain in the hospital, it would cost “north of $1,500 a day.” Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care."

Sure. https://www.theguardian.com/world/2019/jun/23/three-netherla...

the very fact that a patient has to be, legally "experiencing unbearable suffering, with no prospect of improvement, and to have a voluntary, sustained wish to die" is ripe for abuse, as the article makes clear has already happened.

A euthanasia proponent said, "Whether things are clear for doctors is a difficult question, as unbearable suffering is different from one person to another."

Maybe the Netherlands: https://www.theguardian.com/news/2019/jan/18/death-on-demand... seems ideal to you. Not to me. Not even to a lot of Dutch doctors.

I'd argue the "experiencing unbearable suffering" part is redundant anyway, since "I'd literally rather die than continue to experience this" is about as close to a definition as you're going to get.

And while any standard of "sustained" and "prospect of improvement" will have their edge cases, that's arguably still better than either absolute of availability.

The problem is ensuring it's truly voluntary, which seems rather difficult

The death of King George V comes to mind. He was very sick, but still alive. His doctor was worried that if he didn’t die fast enough, his death would be reported by tabloids, not the “respectable press.”

So he was given a sedative against his will. His last words, “God damn you”, we’re shouted to the nurse injecting him. Then he was poisoned to death.

And of course things went bad in Germany. “Euthanasia” was not a Nazi innovation. It was being advocated in Berlin throughout the 1920s, from very humane motives.

It was relegalized in Germany a few years ago - I don’t know why it’s excluded from the list of countries that allow it. Bad optics?

That is kind of horrifying, considering his family were not aware of this either, and neither was he consulted about it.

My understanding about George V is that his son, future Edward VIII - an all-around asshole - was pressuring the doctor to euthanize him.

So “the family” knew.

But the “the family” was more interested in securing his inheritance and title.

Which is ironic considering how quickly he threw it away.

I mean the Canadian government highlighted the "cost savings" when they passed the legislation.

https://www.pbo-dpb.gc.ca/web/default/files/Documents/Report...

"The predicted gross reduction in health care costs amounts to $109.2 million while the cost of administering MAID is estimated at $22.3 million. Thus, the difference between the two represents a net cost reduction for provincial governments of $86.9 million."

I’d expect (or at least hope) any piece of legislation with a significant cost component would have a projection of those costs included.

There is a significant cost to providing care in the last year of a person’s life. It would seem opaque or “hiding something” if legislation around assisted suicide failed to discuss financials entirely.

Not inferring the analysis was sinister. Just the incentives.

The Parliamentary Budget Office is independent and nonpartisan. It's literally their job to provide cost estimates for parliamentary proposals. They're designed to hold the governing party accountable for the financial implications of proposed legislation.

It's perhaps also worth noting that with 38 million Canadians, you're talking about roughly $2 per person. I don't think that's a meaningful amount of money at the national level. Government spending on healthcare is roughly $8000 per person.

> "duty to die"

Uncomfortably close (linked from article):

"His words were 'assisted suicide death was legal in Canada,'" she told CBC. "I was shocked, and said, 'Well, I'm not really interested,' and he told me I was being selfish."

https://www.cbc.ca/news/canada/newfoundland-labrador/doctor-...

And from the article:

Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care.

“Roger, this is not my show,” the ethicist responded. “My piece of this was to talk to you, (to see) if you had an interest in assisted dying.”

https://www.nytimes.com/2017/06/16/us/suicide-texting-trial-...

Is involuntary dying really worse than involuntary living? Personally I’d much rather risk the former than the latter.

I mean if you’re still alive you can always die another time - or not. But when you die, that’s that. No more options.

Medical ethics usually desires preserving options down the road as much as possible.

> if you’re still alive you can always die another time

Well, not very easily if I'm legally prohibited from doing so! IMO medical ethics is wrongly biased towards preserving life at all costs.

Being a doctor or nurse or other medical professional should be about sustaining and improving health.

If euthanasia is to be a thing, it should not be carried out by doctors or nurses. It should be a different profession entirely.

Trying to reuse existing professions and institutions for euthanasia simply because they possess the required medical knowledge is short sighted, and creates an obvious conflict of interest in many cases.

Euthanasia should not be considered a medical or health choice/procedure. It is a different kind of choice/procedure entirely. We are already in a situation where insurance companies and governments will say "we'll pay for procedure X but not Y". If euthansia is considered to be a procedure, just like any other, people will find themselves in the situation where euthanasia is the only procedure that will be paid for.

If you want to move this debate beyond the theoretical, then the best thing you can do for yourself and your loved ones is to make sure that you have set up proper legal documents (living will, advance directive, medical power of atty, etc). The last thing you want is for the state or some institution to decide these things for you when you are unable to, or for your family to squabble about it since you didn't leave them instructions. Your medical power of atty should empower a person you trust to carry out your wishes.

I encourage everyone who’s having a strong reaction to this to read through the statistics[0] of who is receiving this care. Perhaps consider why you don’t hear about the success stories.

0: https://www.canada.ca/en/health-canada/services/medical-assi...

> prompting doctors and health workers to suggest the procedure to those who might not otherwise consider it.

Please tell me there isn't a financial incentive behind this. The only thing worse than doctors suggesting opioids to those who might not otherwise consider it is doctors suggesting death to those who might not otherwise consider it.

There’s always a financial angle in most situations. After all, taking care of a really sick patient (or someone with a difficult condition) costs the state money. If you read the article there are sighs that this may have been a consideration in some cases they list.

Wow, that's completely correct. From the article:

"In one recording obtained by the AP, the hospital’s director of ethics told Foley that for him to remain in the hospital, it would cost “north of $1,500 a day.” Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care.

"“Roger, this is not my show,” the ethicist responded. “My piece of this was to talk to you, (to see) if you had an interest in assisted dying.”

"Foley said he had never previously mentioned euthanasia. The hospital says there is no prohibition on staff raising the issue."

I'm shocked. For the benefit of the doubt, since the quote doesn't include broader context, it's possible that the information was relevant in some way independent of guilting the patient, or the ethicist was being unintentionally awkward.

But given the information presented in the article, it's not a good look for the hospital, which should be prioritizing patient outcomes far above cost savings.

I have a very hard time believing that doctors will be suggesting euthanasia to patients who might not otherwise consider it.

There is no financial incentive behind it on a personal level for doctors, given Canada's one-payer medical system, and euthanasia is counter to many doctors' interpretation of the Hypocratic oath.

You could argue that on a system-level there is an incentive to encourage euthanasia, since it could take expensive terminal patients off the bill. This bit does make many people (myself included) uncomfortable and there definitely needs to be checks and balances in place.

A one payer system doesn’t insulate doctors from personal incentives to cut costs.

The details of compensation can easily encourage one time injections over long term care.

Even if the injection is poison.

I know for a fact that “bounty” type programs are used by Canadian public health authorities, and for-profit actors make money from them.

I don’t know if this extends to long-term care scenarios, but there’s nothing about the way the Canadian health system is structured that offers strong protection against perverse incentives.

Arguably, the horrible US for-profit health system offers stronger protection against this. A dead patient can’t be charged for more services. But a system that equates medical consumption with good care has it’s own set of problems too obvious to mention.

Respectfully this just display ignorance on how doctors are compensated in Canada. They are paid by the act, meaning that "doing X" gives them money. Euthanizing someone is compensated as a single act so there really isn't an incentive to do it. Most doctors are actually refusing to do it because of their oath (and yes they can refuse).

Plenty of "specialists" make their living this way.

This post (and many others here) kind of put the ignorance of the "Canadian" system on display. It's not really one uniform system and has varying levels of privatization across the country because it is handled by provinces.

> Arguably, the horrible US for-profit health system offers stronger protection against this. A dead patient can’t be charged for more services. But a system that equates medical consumption with good care has it’s own set of problems too obvious to mention.

This isn't stronger protection; it just creates a different perverse incentive to effectively drag out someone's suffering.

> It's not really one uniform system and has varying levels of privatization across the country because it is handled by provinces.

Does that structure offer strong protection against perverse incentives in all provinces?

> I have a very hard time believing that doctors will be suggesting euthanasia to patients who might not otherwise consider it. There is no financial incentive behind it

This article provides evidence to the contrary:

I’d note that the hospital administration was mentioning this, rather than a particular doctor providing care. Or, the former has a financial incentive to keep care costs low (especially given the current government in Ontario).

The one person named was an administrator, but it's not particularly clear who the "staffers" were. It's possible some of them were doctors, but it's hard to say.

That said, I feel like the point here was that it wasn't likely to be pushed at people who hadn't asked, and yet it was, not that it was uniquely bad coming from a doctor vs. an administrator.

The comment you quoted explicitly mentioned doctors and specifically mentioned the Hippocratic oath. You omitted that part of the sentence from the quotation in your reply but it was very clearly about Doctors.

But "staffers" may well include doctors, and there's nobody here who can say either way unless someone steps up with the recordings. I left out the rest because I wanted to point out that there are people with financial incentives who did push this and I don't see why it matters if they're doctors or "staffers" or the hospital's Director of Ethics.

If the Director of Ethics and their staff think this is appropriate, it'd be more surprising if the doctors didn't engage in the same.

There are doctors who cut off foreskins of babies who would never ever consider it. Get it into your head that many doctors don’t have a real moral center.

You should talk to disabled folk about how they are often treated by doctors. It's often a version of average people telling them "if I had what you had, I'd kill myself" (a disturbingly common statement), but with the added dimension of having a lot of power over the patient.

I initially thought along the same lines from first principles, that there is no incentive for physicians to suggest euthanasia.

But in addition to the case from Foley quoted by another commenter, the article backs it up with another claim given by a named source: "Frazee cited the case of Candice Lewis, a 25-year-old woman who has cerebral palsy and spina bifida. Lewis’ mother, Sheila Elson, took her to an emergency room in Newfoundland five years ago. During her hospital stay, a doctor said Lewis was a candidate for euthanasia and that if her mother chose not to pursue it, that would be “selfish,” Elson told the Canadian Broadcasting Corporation."

So, it looks credible that it's happening in practice. I can only speculate as to why, but I revised my initial belief because it was hypothetical, after reading about the accounts that look objective.

Surely there is an ethical duty for the doctor to offer options. It is not for them to decide what path the patient should take and holding back something that the patient may want is unethical.

Maybe it's just me, but if a stranger can talk you into killing yourself - what the fuck else can a stranger talk you into doing?

Maybe people need to take some responsibility, instead of arguing the existence of Dr Evils in medicine.

You’ve heard of the Milgram experiment? It specifically focused on medical authority.

Like almost all pop psychology, it is not very scientific:

https://www.discovermagazine.com/mind/the-shocking-truth-of-...

Hey, don’t smear all psychology with the taint of social psychology. Psychophysics and psychometrics replicate.

You mean people with dementia or other degenerative brain diseases, should just pull themselves by the bootstraps and take more responsibility and debate their best?

There was a girl convicted of telling her boyfriend to kill himself: https://www.buzzfeednews.com/article/tasneemnashrulla/michel...

In general I agree with you, but there are s lot of really people that fall for scams that seems hard to fall for for most of us.

A hospital administrator might be under pressure from a Provincial government to improve “efficiency” and keep beds available, but your average doctor/nurse likely isn’t incentivized for that sort of outcome.

Canadian elections are generally won in suburbs, so Provincial governments are generally hesitant to increase quality of care via tax revenues. This usually results in discussions of federal funding to improve care outcomes.[1]

[1] https://globalnews.ca/news/8590853/canadian-premiers-new-pol...

So if we let hospital administrators pressure people into assisted suicide all's good?

No, I personally wish voters in each of the Canadian provinces would understand that taxpayer money on healthcare is well-spent. They should be voting for Premiers and cabinets that aren’t going to create this environment.

The problem is the logic can lead you down a bad path.

1. Let fully lucid patients make a decision to die.

2. Let partially lucid patients make a decision to die.

3. Let family members of non-lucid patient makes a decision to die.

4. Let doctor make a decision for a patient who "would clearly want to die if they could speak".

I'm deeply disturbed by the tone of the comments here in general, as people seem to be missing the problem.

The problem is that the government and health care institutions have a conflict of interest in euthanasia.

A citizen that is costly to you? Wouldn't it be convenient if they disappeared? Wouldn't it be even better if they believed this was in their own best interests?

I think a legitimate argument can be made that in many of these cases, Canada is simply killing its citizens rather than try to provide services, and essentially blaming it on the citizens or fate.

I'm a huge supporter of assisted suicide. I believe it's a fundamental form of autonomy. But I also believe that people can be in positions where they are incapable of offering informed consent, and also strongly believe those in a position to assist cannot be in a place to assist in deciding. There needs to be a firewall in between. Probably a step further, in that there needs to be someone openly arguing against euthanasia as a matter of course, to ensure there is an advocate for that position.

Think of it this way. Let's say a person is mentally incapable of consenting — they have a severe cognitive disability, or are a child. They are falsely accused by the state of a capital offense, because it unethically benefits the state (eg, to protect corrupt police). If they convince the accused of their guilt, does it make ethically acceptable? What if the accused is capable of consent, but is lied to and brainwashed about their guilt, and manipulated into believing they are guilty?

In those cases, doesn't it still make sense to have a legal advocate for their innocence?

How is that fundamentally different?

> The law was later amended to allow people who are not terminally ill to choose death, significantly broadening the number of eligible people. Critics say that change removed a key safeguard aimed at protecting people with potentially years or decades of life left.

Here's the thing. If I want to die at 80 because I don't want to live past that point, that is my choice. Even if I have no "illness". If I don't want to be a drooling, pants-shitting, waking-up-5-times-a-night-to-piss, wheelchair-bound, mushy-food-eating, dotty old fuck, the state should not be able to mandate that that's how I spend the last 10 years of my life. I already know that I don't want to regress into infancy just to squeeze out more time. I have had a shit-ton of life already and I'm not even halfway there. The last thing I want in life is for my last 10 years to be miserable.

I will buy a gun, or jump off a bridge, or freeze to death, or O.D. on heroin, or something else if I have to. But I shouldn't have to.

That said, there has to be strong protections against people being put in a position where they feel they have to, or somebody else gets them to, choose euthanasia. There should be a rigorous, wide-ranging, and not-super-slow process to establish without a doubt that, yes, this person is of sound mind, this is only their decision, they are informed, etc. We need both the freedom to choose, and to look closely to make sure they did choose. I think Canada's efforts are extremely noble, and I'm sure that a positive, proactive, intelligent approach can thread the needle. What won't help is FUD, which is what this news article feels like to me. For example, I don't see quotes from people who inspired expanding the laws in the first place.

> the state should not be able to mandate that that's how I spend the last 10 years of my life

The number of things that the state should not be able to mandate but does is immense. Unfortunately “should not be able to” is irrelevant in modern society. For some reason we all accept constant overreach into private affairs they affect no one else.

Could you give other examples? It seems to me that the balance between individual freedom and restrictions is pretty good in most western countries (I don't know much about other continents).

Conscription...done.

Well conscription almost doesn't exist any more in western countries. And I don't think it's a good example of something that doesn't affect anyone else, the idea is to train people in case of a war. Having people able to defend the country seems quite useful for everyone in unstable times.

Is Switzerland not a "Western country"? Several other countries in Europe (and many more throughout the world) still have conscription.

Even the US still requires you by law to register for the draft[1] and technically still has the legal right to conscript you[2], though since 1973 they (as a matter of policy) no longer do this:

> However, conscription remains in place on a contingency basis and all male U.S. citizens, regardless of where they live, and male immigrants, whether documented or undocumented, residing within the United States, who are 18 through 25 are required to register with the Selective Service System. United States federal law also continues to provide for the compulsory conscription of men between the ages of 17 and 45 and certain women for militia service pursuant to Article I, Section 8 of the United States Constitution and 10 U.S. Code § 246.

[1]: https://en.wikipedia.org/wiki/Selective_Service_System [2]: https://en.wikipedia.org/wiki/Conscription_in_the_United_Sta...

I don't know...person going along living his life, gets drafted, sent to war and dies. He wasn't bothering anyone.

He's not affecting anyone else until after you draft him.

While it may be useful for the country, it is certainly at odds with individual freedom.

While there isn't much mandatory military service left in western countries, it is far from gone. And this doesn't speak to the countries with the potential to draft, which is many.

There was a lot of talk about conscription being gone in Europe, up until 2014.

Then that whole Crimea thing happened.

Since then, no European country had dropped conscription, and several have re-instituted it.

The West is not uniform. Some parts of it are far enough from serious threats that they don't need conscription. But this is only possible because there are other countries to serve as a buffer, and they generally do have conscription.

(Well, or you're on a different continent entirely, and that is your primary defense.)

If we own our lives, then surely the ultimate decision that we should be allowed to make is whether to continue with it or end it.

Percentage of people that plan to kill themselves, but simply fail to do so because something minor happens to interfere is not small; as in they do not end up committing suicide and never try again.

If someone really wants to kill themselves, no reason to make it easy, it should by definition be hard to do, since there is no undoing it.

If someone wants to kill themselves and is physically able I very much doubt that going through the legal process would be the easy way out.

How does an old man in a wheelchair kill himself? Why should it be so hard for him? What if he fails? He gets to live even longer in more anguish and humiliation?

90% of suicide survivors do not attempt again.

Why is that?

Research shows that those who attempt suicide once statistically speaking have distinct risk factors and characteristics which are notably different than those who attempt again; among other notable differences, their last attempts statistically speaking are more likely to be lethal. Simply put, they’re not comparable.

Example of related research:

https://www.frontiersin.org/articles/10.3389/fpsyt.2020.6051...

Not going to give advice on committing suicide, understand your point, and as it relates to myself, I am fine dealing with the situation regardless of what happens. Study the topic since I was a child, understand it well, and if you believe such rights are needed, then it’s up to you to make them real before they are needed. Posting anonymously online will have little to no impact.

I have incurable cancer and I'd really like to die on my own terms. Why should that be hard? Today it is still way too hard in most of the world (including in countries that have MAID). Also, it's not just about it being "hard". Sure I could blow my brains out, but I'd like to have the option to die with my loved ones by my side without traumatizing them (or getting them in potential legal problems).

Obviously, significant percentage of people if they were in your situation would likely relate to your wishes to be in control, it’s completely reasonable. Also, reasonable that prior to you being in the situation that it’s likely that the topic was not pressing for you.

Most people don’t want to think about intentionally dying, it’s unpleasant, frequently results in emotionally sensitive exchanges, etc — so they simply avoid the topic.

Basically, being terminally ill is separate topic from the comment you replied too, which relates to legalized assisted suicide for non-terminally ill people; realize OP comment potentially covered it, but at least for me, that was not an issue.

Not the best at exchanges like this, but sincerely hope you are able to find the resolution you seek.

I'm not considered terminally ill yet by most "official" definitions (you have to have months to live). I'm lucky to have a cancer that so far response to treatment to slow it down substantially. This is relevant to the discussion because it means I'm more or less in the same position as the non-terminally ill people you are talking about. In my locale there are euthanasia laws, but they require that I suffer unbearably before euthanasia is allowed. I do not like this prospect one bit. I'd much rather die before reaching that phase. So the reality is that people's discomfort with death will potentially cause me great suffering. This makes this discussion very personal to me. Even though it might seem to you my situation is substantially different.

Thanks for clarifying, unlikely I am able to say anything that would be of use, but it’s obvious you’re actively trying to find solution that works for you. Again, thank you!

>If I want to die at 80 because I don't want to live past that point, that is my choice.

I think most reasonable people can agree with this. It gets more complicated when its a depressed 20 year old saying it.

People here are talking about this as if it’s the suicide booth from Futurama. It’s not.

The overwhelming majority of cases are extensions of palliative care made by people of sound mind.

>The overwhelming majority of cases are extensions of palliative care made by people of sound mind.

That's the case now, and I fully support the right of someone who is suffering or otherwise debilitated due to age, disease or injury to end their life with the full support of the medical establishment. What will the outcome be if the law is expanded? Will people who might otherwise survive and live long, healthy and productive lives opt for euthanasia if the course of treatment means huge medical bills that will forever immiserate them and their families? It is one thing to support giving people control over their own lives and their own suffering, and another to create all sorts of financial incentives, for patients, insurers, hospitals and doctors to consider euthanasia as an alternative to treatment.

Here’s an idea. I’m a 25 year old in Canada without any particular gift or grace of intelligence. Unless I want to work at Walmart for the next 30 years and survive in government housing, life is pointless.

So… I might as well grab a car, execute the greatest crime in my power for the sheer fun of it, and demand euthanasia at my sentencing.

Now I’ve got quite a moral dilemma for the judge. If you grant me my wish, I will die completely unrepentant and my victims will be denied a sense of justice forever. Death was my wish, their suffering my parting joy. If you don’t, how dare you keep me alive against my will.

If you think this is obviously wrong, why?

How do you tell the difference between someone suffering from depression that wants to die but could cure their depression and someone that just wants to die? Depression is an illness and it makes people do and say all kinds of things they wouldn't normally.

What if you are 80 and just have low testosterone and want to die but then you start trt and things really get a lot better? Which "you" wanted to die and which should get to make that decision? What is the authentic you?

https://en.wikipedia.org/wiki/Ship_of_Theseus

I'm all for making people's lives better. But people deserve the choice of what treatment they will or won't accept. That's what informed consent is about. We don't force surgeries on people just because they have a good prognosis; the person still has to consent to the surgery (if they are capable).

Even if there is a treatment with a very good prognosis that could magically make you happier, you deserve the right to say "no" anyway. So let's absolutely make sure somebody is informed and of sound mind before we put euthanasia on the table. But let them have agency over their own life after that.

Feel it is likely you are over estimating modern medicine’s ability to judge if someone is of sound mind.

There are some difficult philosophical questions here. If someone has an ailment, that is causing their mind to think euthanasia is the answer, but if they had the treatment to the ailment, they would no longer think so, are they of sound mind? I'm not sure where the line is on that, and i think its far from obvious.

Agreed. Likewise though, there's an ethical dilemma the other way: Is it acceptable to force treatment on someone?

These are not easy questions and while I personally believe that assisted dying legislation will prevent a lot of needless suffering, I also believe there will be people effectively killed by this who could have otherwise had fulfilling happy lives but couldn't see the path out of the woods or were unable to make that journey.

I thought the Canadian standard required that the problem be incurable.

At some point, you just accept that people get to make important choices about themselves, and will sometimes make ones that don't necessarily make sense.

I hope 80 doesn’t look like that for most people. Even aging rock stars are still moving at 80:

https://en.m.wikipedia.org/wiki/Mick_Jagger

https://en.m.wikipedia.org/wiki/Paul_McCartney

Willie Nelson is almost 90 and still touring:

https://en.m.wikipedia.org/wiki/Willie_Nelson

To be fair, these people are not most people. All have a LOT of money to throw at their health. Also at carers, cooks, healthy living, and all the modern conveniences that make old age bearable. Same with William Shatner, he’s 91 now!

My parents are 78 and 80. Old age is slowly catching up with them. But my dad can still stay out in the yard for hours at the time and until Covid, my mom was still tutoring friends kids and grandkids in advanced math. She is still completely comfortable with driving from my hometown 5 hours to where I live - a place with some of the worse traffic in America. They were not “rich”. My mom is a retired school teacher and my dad is a retired factory worker. They retired at 55 and 57.

My dad still keeps active and he practices karate katas multiple times per week.

Maybe but it seems like your parents have their health and were taking care of themselves.

I'm in my thirties. I'm already suffering from obesity, have chronic pains in the wrists and shoulders and leg, and my hearing and vision are starting to deteriorate, and I've had multiple bouts with gout that leaves me barely able to walk for months at a time.

If my thirty's are already this bad, I can't imagine lies in store in my 40's, never mind 80's.

Many people say this when they’re young. Almost no one goes through with it. Maybe the drooling isn’t as bad as you think.

How is this knowable when barely anyone has access to assisted suicide outside of a few small states/countries? And even then, drooling does not qualify in most.

OP mentioned various alternatives.

Assuming you are referring to:

>I will buy a gun, or jump off a bridge, or freeze to death, or O.D. on heroin, or something else if I have to. But I shouldn't have to.

Those are not equivalent to the experience of dying with assisted suicide.

Overdosing on heroin very much is. You’ll leave an uglier corpse given the blackening of the extremities but you fall asleep and then you suffocate.

Everyone is different, some people have a very difficult time dealing with even minor issues. Also, based on the way most people live their lives, I don’t think the average person truly understands what’s ahead, or if they do, pretend they’ll magically escape it. Personally, I am fine with my future regardless of what happens, but it’s not surprising to me some either don’t want to grow old or are caught off guard by the reality of old age.

>Almost no one goes through with it.

I don't necessarily share OP's sentiment, and I think it's great that people don't go through with it, but I strongly believe that the option should legally be afforded to them.

According to https://theconversation.com/in-places-where-its-legal-how-ma... (as of 2019) between 0.3% and 4.6% of all deaths are assisted suicide or euthanasia in jurisdictions where it’s legal.

The paper they report on further notes:

pain is not the main motivation for PAS (physician-assisted suicide)… The dominant motives are loss of autonomy and dignity and being less able to enjoy life’s activities.

The point of the article is that in Canada at least, many people go through with it.

I think the reason people don't end up killing themselves is that actually committing suicide is technically difficult, and terrifying. If one doesn't have access to specific drugs, how does one do it without making a horrible mess that their loved ones would have to clean up?

Even if one can somehow avoid the mess, suicide tells the people who are left behind that one chose death over them; it's a terrible message that most people, justifiably, don't want to send.

A medical decision that leaves little to no trail is a much better outcome for everyone.

I think this is a really good point.

I support people being able to have autonomy over their lives (and their deaths). But, as you say, we need to eliminate effective coercion and this has a lot of implications.

For example, no one should ever feel that this is a way out of crippling medical debt or debt they may leave to their family.

So if you think about it, legalizing euthanasia is essentially predicated on having an adequate social safety net, access to mental health resources and access to health care, all of which I support.

Apnews, like Facebook, needs sensationalist content to sell ads.

AP revenue is primarily content licensing [1]

You could perhaps argue that since their customers probably get their money primarily through ads so AP needs to generate sensationalist content to keep them happy.

They (and perhaps Thomson Reuters) themselves don't need ads to make money that is not their business model (while they do have ads revenue as well it is not key to their business )

That isn't to say AP's quality has not dropped over the years it certainly has. It seems more like given the pay journo's make these days, top talent is simply no longer interested in the field. Economic pressures of online journalism does not reward knowledgeable people taking the time to write well informed pieces, rather content mills are more likely to make money with low quality output.

To me this is more a reflection of us as consumers not paying for quality rather than industry which merely adapts to what users want and pay for ( whether with subscriptions or eye balls)

[1]https://www.ap.org/about/annual-report/2021/ap-by-the-number...

U.N. human rights writing about Canada's failure to fulfill the Universal Declaration of Human Rights is hardly sensationalist clickbait.

The biggest horror of the situation is that many disabled but otherwise healthy people are ending up in the MAID system because of the extreme cost of living in Canada that the disability support system has made no attempt to keep up with.

Vancouver and Toronto are both on the top 10 most unaffordable cities on Earth, and it's literally killing people.

It is horrible if people are forced into MAID because of monetary issues, but that should obviously be addressed by improving their financial support, not by taking away the option of MAID.

That's not happening because MAID is much cheaper. That's the way it is in my part of Europe anyway.

But other “experts” created the system in the first place:

> Canada’s road to allowing euthanasia began in 2015, when its highest court declared that outlawing assisted suicide deprived people of their dignity and autonomy. It gave national leaders a year to draft legislation.

Who cares what experts think about what’s fundamentally the regulation of morality?

Curious that this article, from August 11, is posted today.

Since no one in the thread has mentioned it, the issue has been in the Canadian media recently due to a situation first reported on August 16 which was updated today. The first paragraph is ample summary of what transpired:

> A Canadian Forces veteran seeking treatment for post-traumatic stress disorder and a traumatic brain injury was shocked when he was unexpectedly and casually offered medical assistance in dying by a Veterans Affairs Canada (VAC) employee, sources tell Global News.

https://globalnews.ca/news/9061709/veteran-medical-assisted-...

And today a full investigation was announced:

https://globalnews.ca/news/9072857/canada-veterans-assisted-...

This is not what is supposed to happen and the Veterans Affairs employee involved will, I expect, be sacked or placed on leave. It is at the very least incompetence or lack of proper training, given that the law has only been in place since 2021.

For anyone looking to understand the issue in the Canadian context, and how we got here, here's my brief non-expert summary.

In 2015, the Supreme Court of Canada decided in Carter v Canada that our Criminal Code's prohibition on assisted suicide was unconstitutional:

https://www.justice.gc.ca/eng/cj-jp/ad-am/scc-csc.html

https://en.wikipedia.org/wiki/Carter_v_Canada_(AG)

That brought about Bill C-14 in 2016, which allowed those whose death was "reasonably foreseeable" to obtain MAiD:

https://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-a...

A further legal challenge, Truchon v Canada, decided by the Superior Court of Quebec in 2019 required further legislative accommodation. This removed the restriction which required that death be "reasonably foreseeable" as it again violated the Charter. Hence the government introduced Bill C-7 in 2021:

https://parl.ca/DocumentViewer/en/43-2/bill/C-7/royal-assent

https://www.justice.gc.ca/eng/csj-sjc/pl/charter-charte/c7.h...

The eligibility requirements are now:

1. Be a mentally competent adult

2. Experience "enduring and intolerable suffering"

3. Complete the process involving paperwork, witnesses, physicians, etc...

I'm not seeing the central issue (imo) discussed, ie. is there a conflict of interest given that the party facilitating death is reducing cost of operation by doing so.

You can't come to consensus (imo) without factoring the answer to this question into your argument.

This is a great article that talks about the legal changes in this area:

https://canucklaw.ca/parliaments-guidelines-on-euthanizing-t...

I think reasonable people can agree that aborting an unborn baby that is conceived 1 day prior is not murder, but a fetus 1 day from birth is a human and killing it is murder. There is some point between 1 day and 9 months where killing the baby is immoral.

Similarly, physician assisted suicide could make sense in some cases. However a chronically depressed patient that is annoying the doctor, I don't approve of offering suicide to. As someone who battled depression for many years and eventually vanquished it, a quick and painless suicide might have made sense when I was at my lowest point. I don't like how easy it has become in Canada according to this article.

[Upvoted despite significant disagreements, because the downvote button isn't a disagree button]

No one is killing fetuses in the 38th week for fun. Not moms, and not doctors.

The reason to keep the legal system out of it is because there are a million things that can go wrong in pregnancies and child birth, and the doctor does not need the added complication of having to think about legal liability in the heat of the moment.

Women make a tremendous sacrifice when choosing to bear children. The issue of abortion is sufficiently handled between the pregnant mother and doctors.

https://www.motherjones.com/kevin-drum/2019/04/raw-data-abor...

A baby that will certainly die at birth, or likely cause death to the mother, is one thing.

A perfectly healthy baby 1 day before birth that is put to death is entirely different. There is nothing magical about birth that makes it OK to slit the throat of a healthy baby.

As a thought experiment, imagine a healthy baby born premature 1 day early. Could you take a knife and stab it to death as it screams and cries? If not, perhaps it is indeed murder.

That’s quite the straw man. Can you point to a case where that actually happened?

Infanticide was a completely normal part of life in almost all historical societies though usually by drowning or smothering because they’re quieter. Exceptions are the Egyptians, Jews, Christians and Moslems. The PRC felt the need to legislate against it specifically when they conquered the last of the RoC holdouts in China in 1949 so I don’t think we need to imagine infanticide.

I am having trouble figuring out why infanticide (killing a baby that has already been born) entered a conversation about ensuring a pregnant mom and doctor are able to make healthcare decisions unencumbered from legal liabilities.

If you read the post I was replying to or the one it was replying to you may be enlightened.

I'll add that the French had an anonymous baby depository for women who couldn't afford to care for their children.

I don't think it's a straw man. They were using a hypothetical scenario as an analogy.

Canada allows abortion through the entire pregnancy.

Usually abortion and euthanizing can be talked about as very different things. But Canadas unusual laws on both invite comparison.

This is a bit misleading. Canada has no abortion laws. It did until the late 80s when the courts struck a law against any abortions as being too restrictive and unconstitutional.

Laws don't typically allow things, they restrict them.

Is there anything like a two-component drug, that you can get the parts of from two different sources, mix yourself, and kill yourself with in a humane way? In that case perhaps part A can be prescribed by one doctor, and part B by another, so no doctor is able to singlehandedly prescribe this lethal drug. I don't know if this solves anything, but it puts friction in they system, which I think is needed.

Suicide drugs exist but they're generally pretty awful ways to go or very illegal to sell. If the police find out suicidal people use your chemical store or pharmacy as their suicide shop, you can get in huge trouble, up to aiding in murder.

I'm 100 in favour of euthanasia for people who are suffering with no end in sight. If I get sick and face ten years of slowly dying, suffering every day, I'm taking the easy way out somehow, and it's up to the government if that's in a controlled environment or if they'll need to send out a cleanup crew when they find the suicide note.

However, I don't think you should be able to just buy suicide pills online. It's the only way to do it relatively safely and successfully for people in countries where assisted suicide isn't legal, but it's a workaround rather than a solution.

this topic came up a few times on hacker news

I will add this link here

https://www.canada.ca/en/health-canada/services/medical-assi...

can't have the little people thinking they control their own lives, can we?

apnews needs to sell ads aparently.

"Experts troubled"? What a weird and wholly opinionated way to report on something.

The planet's overpopulated. Help people die if they choose to do so. It's a lot less messy that way, for everyone.

Please read the article.

You could also try to make as many people gay as possible.

It's the main reason why I like gay people... they don't reproduce.

why the down votes? I can't like whoever I want? Im part of the LGBTIQZ community

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